Surgical ligation clip and method for use thereof

ABSTRACT

The clip applier of the current invention solves the problems of prior art tools by incorporating a pre-clamp mechanism, the function of which is to pre-clamp the vessel to be ligated to a dimension such that the center leg of the spring of the ligation clip need be lifted only slightly. In this manner the spring clip can be slid over the smaller pre-clamped dimension. This insures that the clip spring material will remain within its elastic limit while allowing the tool to maintain a low profile for use in endoscopic surgery, even on large diameter vessels.

The present application is a continuation of application Ser. No.09/441,898, filed Nov. 17, 1999 now U.S. Pat. No. 6,607,540; which is acontinuation of application Ser. No. 08/766,193, filed Dec. 12, 1996,now U.S. Pat. No. 5,993,465; which is a continuation of application Ser.No. 08/316,730, filed Oct. 3, 1994, now U.S. Pat. No. 5,858,018; whichis a continuation-in-part of application Ser. No. 08/111,634, filed Aug.25, 1993, now abandoned; the disclosure of which is incorporated byreference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to mechanical devices used insurgical procedures to obtain ligation or hemostasis, and moreparticularly, to low profile tools that can apply a preformed, springloaded ligation clip used during surgery to clamp around a vessel orduct, such as the cystic duct, and thereby obtain ligation.

2. Description of the Prior Art

It will be appreciated by those skilled in the art that the use ofligation clips to control bleeding during surgical procedures is wellknown. As described, for example, in U.S. Pat. Nos. 4,976,722 and4,979,950, prior art clips are generally formed of metal wire, usually atitanium alloy, having a “U-shaped” rectangular cross-section. Suchprior art clips often include a grooved pattern machined into the inneror clamping surfaces of the clip, in an attempt to enhance the abilityof the clip to remain in position after it is closed around the vessel.Application of the clip to the vessel is normally effected by means of acrushing action produced by a clip applier, such as that disclosed inU.S. Pat. No. 5,030,226. Such crushing actions, of course, permanentlydeform the clips, making them difficult to remove or re-position.

Prior art surgical ligation clips have several inherent problems. Forexample, the force applied by the clip to the vessel can be variable andinconsistent from one clip to the next, because of the variation incrushing force applied to the clip by the user. Further, prior art clipshave a tendency to slip off the end of the blood vessel stub (i.e.,parallel to the axis of the vessel) to which it has been applied,because of the low coefficient of friction associated with the clip, andlack of adequate restraining force provided by the clip. Because ofthis, separation of the clip from the vessel to which it has beenapplied, after the wound has been closed, is not uncommon. A relatedproblem found in the prior art is the fact that the ligating orrestraining force offered by the crushed clip varies along the length ofthe clip, decreasing toward the open end. Thus, the section of thevessel near the open end of the clip can be inadequately ligated.

It is also common in the prior art to actually form and crush the cliponly at the time of its application to the targeted blood vessel. It isoften required that vessels of 4 mm and larger diameter be ligated.Because most clips of the prior art have no spring action it is requiredthat the inside clearance dimension of the clip, prior to crushing, belarger than the vessel. This does not lend itself to clip applierdesigns that will pass through small 5 mm trocars. Accordingly, the clipapplier mechanism of the prior art must be relatively large andcumbersome. This is a particular problem in laparoscopic procedures,during which both the clip and clip applier must be inserted through atrocar placed through the patient's external tissues and into thesurgical field. Thus, prior art ligation clip appliers used inlaparoscopic procedures universally consist of a 10 mm diameter clipapplier that can fit only through a trocar having a 10 to 11 mm diameterentry port. Because one goal of laparoscopic surgery is to minimize thesize of the entry wound, a surgical ligation clip and clip applier thatcan be used within a 5 mm diameter trocar port is highly desirable.

To address these problems, a new and improved surgical clip wasdesigned, as illustrated in FIGS. 1 and 2 and in U.S. patent applicationSer. No. 08/111,634 filed on Aug. 25, 1993. The improved clip has avessel clamping arm, a vessel support member, and at least one tensioncoil integrally joining the arm and support member. The clip ispre-formed so that in its equilibrium state, it can be easily placedwithin the surgical field, including through an endoscopic trocar portwith as little as a five millimeter diameter. After the clip is placedproximate the blood vessel or duct to be clamped, the clamping arm ismoved from its equilibrium position to a position under higher tension,allowing positioning of the vessel between the arm and support member.When correct placement and positioning is achieved, the arm is releasedand, as the arm tends to move back towards its equilibrium position, itclamps the vessel between the arm's curved lower surface and thesupporting upper surface of the vessel support member.

To enhance the performance of the tension coil(s), the vessel supportmember includes first and second arms, one of which terminates in a loopsection. Minimal cross-sectional area of the clip is achieved bysubstantially longitudinally aligning the vessel support member, theclamping arm, the loop section, and the tension coil.

The clamping arm is pre-formed into an equilibrium that generally alignswith the horizontal plan of the support member. A second embodiment ofthe clip pre-loads the clamping arm into a relaxed position where thefree end of the arm rests against the upper surface of the supportmember.

Unfortunately, several problems are encountered in applying this novelpre-formed, spring-action ligating clip onto a vessel through a 5 mmtrocar port. First, the nominal 5 mm cross section of the clip that isinserted through the trocar places severe design restrictions on anyapplier mechanism. Traditional “crush type” clips require a crusher andanvil type applier mechanism which is too large to pass through a 5 mmtrocar. Second, care must be taken so that the elastic limit of thespring material is not exceeded when the clip is opened up so that itcan be placed over the vessel diameter. For titanium wire of diameter0.75 mm, for example, lifting the distal end of the center leg of thespring much above 2 mm will exceed the elastic limit.

What is needed, then, is a clip applier tool that may be used to place apre-formed, spring action ligation clip around a large diameter vesselwithout permanently deforming or weakening the clip, one that willcompress, without crushing, the vessel, and yet be small enough to usethrough a 5 mm trocar.

SUMMARY OF THE INVENTION

The clip applier of the current invention solves the problems of priorart tools by incorporating a pre-clamp mechanism, the function of whichis to pre-clamp the vessel to be ligated to a dimension such that thecenter leg of the spring of the ligation clip need be lifted onlyslightly. In this manner the spring clip can be slid over the smallerpre-clamped dimension. This insures that the clip spring material willremain within its elastic limit while allowing the tool to maintain alow profile for use in endoscopic surgery, even on large diametervessels.

These and other objects of the present invention will be apparent fromreview of the following specification and the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view in a somewhat schematic form of the deviceof the present invention.

FIG. 2 a illustrates in perspective the clips of the present inventionwithin the cartridge of the device.

FIG. 2 b illustrates a perspective view of one embodiment of a ligationclip according to the present invention having a base (or supportmember) and a pressure arm (or clamping arm) for which the applicator ofthe present invention is designed.

FIG. 2 c is a cross section of the ligation clip of FIG. 2 b along theline C-C of FIG. 2 b.

FIG. 2 d is a side view of the ligation clip shown in FIG. 2 b with theligation clip opened.

FIG. 2 e is a top view of another embodiment of a ligation clipaccording to the present invention having a base (or support member) anda pressure arm (or clamping arm).

FIG. 2 f is a side view of the ligation clip of FIG. 2 e.

FIG. 2 g is a top view of the ligation clip of FIGS. 2 e and 2 f afterapplication to a blood vessel with the pressure arm in a clampedposition.

FIG. 2 h is a side view of the ligation clip of FIGS. 2 e and 2 f afterapplication to a blood vessel with the pressure arm in a clampedposition.

FIG. 2 i is a top view of another embodiment of a ligation clipaccording to the present invention having a base (or support member) anda pressure arm (or clamping arm).

FIG. 2 j is a side view of the ligation clip of FIG. 2 i.

FIG. 3 shows a perspective view of the device of the present invention.

FIGS. 4 a, 4 b and 4 c show side, top and end views of the device of thepresent invention in the at rest position.

FIGS. 5 a, 5 b and 5 c show side, top and end views respectively of thedevice of the present invention with the clip assembly advanced to theready position.

FIGS. 6 a, 6 b and 6 c show side, top and end views respectively of thedevice of the present invention with the pre-clamp arm opened.

FIGS. 7 a and 7 b show side and top views respectively of the devicewith the pre-clamp arm pressing a vein and the clip opened forengagement with the vein.

FIGS. 8 a, 8 b and 8 c show the side, top and end views respectively ofthe device of the present invention with the pre-clamp arm closed andthe ligation clip opened.

FIGS. 9 a, 9 b and 9 c show the side, top and end views of the device ofthe present invention in the position as occurs immediately followingthe position as shown in FIG. 8.

FIGS. 10 a, 10 b and 10 c show side, top and end views of the device ofthe present invention with the clip assembly extending beyond the end ofthe sleeve and the wings of the device releasing the clip.

FIG. 11 shows a cross section of the device of the present inventionalong the length of the trunk.

FIG. 12 shows a cross section of the device of the present inventiontaken to the left of the trunk.

FIGS. 13 a and 13 b show a mechanism that can be incorporated in thedevice of the present invention to control advance of the clips into theready position in the clip carriage.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to FIG. 1, there is shown generally the preferredembodiment of the present clip applier. The device is indicatedgenerally by the numeral 10. The device 10 includes the pistol grip 12and an applicator sleeve 14. The applicator sleeve 14 contains a numberof ligation clips 16 all in stacked relation and held in position in themanner hereinafter described. The ligation clips 16 are stackedgenerally in the trunk portion of the applicator sleeve 14 and extendfrom the end of the sleeve 14 that is connected to the pistol grip 12toward the distal end 18 of the device 10.

FIG. 2 b shows the shape and construction of a typical ligation (orsurgical) clip 16 which device 10 of the present invention is designedto apply during surgical procedures. Ligation clip 16, additionalpreferred embodiments of which are shown in FIGS. 2 e-2 h and FIGS. 2 iand 2 j, is formed generally of a resilient, continuous, wire typematerial such as titanium or stainless steel, preferably round in crosssection. Ligation clip 16 is bent to define a base (or support member)20 and a pressure arm (or clamping arm) 22. Base 20 and pressure arm 22are connected at their proximate end 24.

As shown, for example, in FIGS. 2 e and 2 i, base (or support member) 20of ligation clip 16 is an elongated U-shaped structure including a firstleg 216 and a second leg 218 joined by a one hundred eighty degree(180°) bend section 220. First leg 216, second leg 218, and bend section220 form a channel therebetween.

As shown in FIGS. 2 b and 2 f, for example, in preferred embodiments,base 20 can be straight. In another preferred embodiment, first leg 216and second leg 218 of base 20, for example, as shown in FIG. 2 i, can becurved upwardly to enhance the clamping force distributioncharacteristics of ligation clip 16. It will be apparent to thoseskilled in the art that, as in ligation clip 16 of FIGS. 2 e-2 h, suchcurvature could be provided alternatively or additionally withinpressure arm 22. Where ease of manufacture is a prime objective, each offirst leg 216, second leg 218, and base 22 can be straight.

In a preferred embodiment, a proximal free end 224 of ligation clip 16is joined by a ninety degree (90°) bend section 222 to first leg 216. Asshown in FIG. 2 f, for example, proximal free end 224 and a segment ofbend section 222 is centrally disposed within tension coil 234. As shownin FIGS. 2 e and 2 i, first leg 216 terminates at its proximal end (awayfrom bend section 220) at bend section 222. Furthermore, as shown inFIGS. 2 e and 2 i, second leg 218 terminates at its proximal end (awayfrom bend section 220) in a loop section 226. Loop section 226 loopsinwardly toward pressure arm 22, as shown, for example in FIGS. 2 e and2 i, and resides in a vertical plane perpendicular to the horizontalplane of base 20.

Pressure arm 22 terminates at a tension coil 234, and a distal free end232 thereof defines the beginning of pressure arm 22. As shown in FIGS.2 b and 2 c, pressure arm (or clamping arm) 22 can overlie and extendgenerally parallel to base 20 and be positioned directly above thechannel of base 20. In another preferred embodiment, pressure arm 22, asshown in FIGS. 2 f and 2 h, can include a curved section 236. Curvedsection 236 of pressure arm 22 moves proximately away from distal freeend 232, terminating in tension coil 234. In yet another preferredembodiment, pressure arm 22, as shown in FIG. 2 j, can overlie andextend generally parallel to base 20, be positioned directly above thechannel of base 20, and contact bend section 220.

The vertical plane established by tension coil 234 is oriented insubstantial alignment with the vertical plane of loop section 226, and,accordingly, perpendicular to the horizontal plane of base 20. Loopsection 226 and tension coil 234 form the connection between base 20 andpressure arm 22. It will be apparent to those skilled in the art thatthe orientation of loop section 226 and tension coil 234, and by formingligation clip 16 of a continuous piece of resilient material, movementof pressure arm 22 will place, as discussed below, pressure arm 22 undertension with respect to base 20. Furthermore, such an orientation willminimize the width and cross-sectional area of ligation clip 16 which ispreferred, particularly in laparoscopic surgery.

When ligation clip 16 of FIGS. 2 a-2 d is in an at rest position,pressure arm 22 overlies and extends generally parallel to base 20 andis positioned directly above the channel of base 20. When ligation clip16 of FIGS. 2 e-2 h is in an at rest position, pressure arm 22 islongitudinally aligned with and oriented between first leg 216 andsecond leg 218 of base 20, but, as shown in FIG. 2 f, below thehorizontal plane defined by first leg 216 and second leg 218. Whenligation clip 16 of FIGS. 2 i and 2 j is in an at rest position,pressure arm 22 rests in a preloaded condition on the upper surface ofbase 20 at bend section 220.

To open ligation clip 16, pressure arm 22 can be rotated about the pointof connection between base 20 and pressure arm 22 at proximate end 24 toopen ligation clip 16. That is, when ligation clip 16 is opened,pressure arm 22 is pivoted about the connection point between base 20and pressure arm 22. The connection between base 20 and pressure arm 22at proximate end 24 is a spring type connection (i.e., loop section 226and tension coil 234) that tends to bias pressure arm 22 back into theat rest position as described previously.

Ligation clip 16 may be opened by separating pressure arm 22 from base20. That separation occurs when base 20 is held in position and pressurearm 22 is forced away from base 20 (as shown, for example, in FIG. 2 d).As shown in FIG. 2 d, pressure is applied to pressure arm 22 to force itto rotate clockwise about the pivotal connection at proximate end 24between base 20 and pressure arm 22. However, when the pressure isreleased from pressure arm 22, pressure arm 22 will rotate about theconnection point between base 20 and pressure arm 22 at proximate end 24in a counter clockwise position back into the at rest direction (asshown in FIGS. 2 a and 2 b).

Looking now at FIGS. 2 g and 2 h, application of ligation clip 16 ofFIGS. 2 e-2 h to a blood vessel 240 to achieve hemostasis is shown.After ligation clip 16 is placed in the surgical field adjacent to thetargeted blood vessel 240, pressure arm 22 is moved upwardly betweenfirst leg 216 and second leg 218 to define a gap and space betweendistal free end 232 and the upper surface of bend section 220. For mostuses, a vertical gap of approximately 1.5 mm will be sufficient betweendistal free end 232 and bend second 220. Ligation clip 16 is thenmaintained in this position so that blood vessel 240 can be manipulatedwithin the space created between base 20 and pressure arm 22. Pressurearm 22 is then released, trapping vessel 240 within ligation clip 16 aspressure arm 22 moves toward its relaxed position.

The curvature of curved section 236 of pressure arm 22 causes arelatively consistent clamping pressure to be placed over the entiresurface of blood vessel 240, thereby achieving effective hemostasis. Byplacing loop section 226 physically adjacent to, and operatively inseries with tension coil 234, a smoother, more consistent application ofhemostatic force is obtainable, while increasing the resistance ofligation clip 16 to deformation.

It will be apparent to those skilled in the art that ligation clip 16 isalso effective in clamping off ducts connecting various organs, thecystic duct, for example. Accordingly, where the term “vessel” is usedherein, it is intended that such reference include all fluid carryingbody structures within the surgical field where ligation or clamping isneeded.

Where the diameter of the duct or other structure to be clamped issubstantially larger than 1.5 mm, a slightly modified method of applyingligation clip 16 is preferred so that the elastic limit of the materialused in the construction of ligation clip 16 is not exceeded. In suchmodified technique, surgical pliers (not shown) of conventional designare first positioned over the area to be clamped and the duct or otherstructure is then compressed to approximately a two wall thickness, or1.5 mm. The pliers are then removed and ligation clip 16 applied asdescribed above. To minimize the risk of over-compression, the plierswill preferably include a means for limiting closure of its laws to aminimum spacing of approximately 1.5 mm. The use of this technique onlarge structures allows ligation clip 16 to be formed with a minimizedprofile suitable for use in a 5 mm trocar, even if the diameter of theduct or other structure to be clamped, for example, exceeds 5 mm.

To remove or re-position ligation clip 16, pressure arm 22 needs merelyto be moved back up into its fully unclamped position, blood vessel 240and ligation clip 16 manipulated as needed, and then pressure arm 22 isreleased towards its relaxed position.

Adding a series of ridges, notches, burrs by machining, etching, orother treatment to the clamping surfaces of base 20 and pressure arm 22can enhance the gripping force of clip 16.

To achieve the objective of minimizing the cross-sectional area ofligation clip 16 of FIGS. 2 e-2 h, thereby permitting it to be used inlaparoscopic surgical procedures, ligation clip 16 is pre-formed intothe position substantially as shown on FIGS. 2 e and 2 f. As such, firstleg 216, second leg 218, pressure arm 22, tension coil 234, and loopsection 226 are substantially in alignment longitudinally. Furthermore,by extending and preloading pressure arm 22 of ligation clip 16 of FIGS.2 i-2 j so that it can assume the position shown in FIG. 2 j, thecross-sectional area presented by ligation clip 16 is further minimized,rendering it more adaptable for use in small diameter trocars.Preloading pressure arm 22, of course, helps to maintain ligation clip16 of FIGS. 2 i and 2 j in a narrow profile until it is positioned forapplication.

As shown in FIGS. 2 e-2 h, in a referred embodiment of ligation clip 16adaptable for placement within an endoscopic surgical field through a 5mm diameter trocar port, the inside diameters of loop section 226 andtension coil 234 are approximately 3 mm. The length of ligation clip 16,measured from the proximal surface of tension coil 234 to the distalsurface of bend section 220 is approximately 12 mm. The width of base20, measured at the outside surfaces of first leg 216 and second leg218, is approximately 2.5 mm. Pressure arm 22 is approximately 9 mm fromdistal free end 232 to its intersection with tension coil 234. In thepreferred embodiment of ligation clip 16 of FIGS. 2 e-2 h, curvedsection 236 of pressure arm 22 will have a radius of curvature ofapproximately 25 mm.

A suitable material from which ligation clip 16 can be formed is wroughttitanium 6A1-4V ELI alloy wire having a nominal diameter of 0.75 mm, andwhich meets ASTM Standard F136-92. Ligation clip 16 can also be made ofwire having a non-circular cross section, or formed from wire having acombination of circular and non-circular sections. For example, tensioncoil 234 and/or pressure arm 22 could be stronger if formed fromrectangular-shaped wire.

When the ligation clip is applied to a blood vessel or artery, thepressure arm 22 is “opened” from the base 20. The clip is inserted overthe blood vessel so that the blood vessel traverses generallyperpendicularly to the direction of the legs of the U-shaped base 20over the top of the base 20 and beneath the pressure arm 22. When theforce that causes the pressure arm 22 to open from the base 20 isreleased, the pressure arm 22 captures the blood vessel between theunderside of the pressure arm 22 and the top of the base 20 to compressthe blood vessel and close it.

Referring now to FIG. 3, at the distal end 18 of the device 10, there isshown generally a pre-clamp arm 26. Pre-clamp arm 26 can also be seen inFIGS. 6 a and 7 a. FIGS. 4 a-10 c all show various views and positionsof the mechanism at the distal end 18 of the device 10.

Referring now to FIGS. 4 a, b, and c, the device 10 is shown in the atrest position. In the at rest position, a clip carrier/activatorassembly 28 (shown generally within the area 28 shown in FIG. 4 a) isretracted within the application sleeve 14. For purposes of thisdescription, the preferred embodiment will be referred to as it isoriented in the drawings. Clearly, if the device 10 was pointed in theopposite direction, the references to right and left would be reversed.The invention will be described with the understanding that the distalend of the invention and of the applicator sleeve are to the left, andthe proximal end of the invention and the elements of it are to theright. Thus, the clip carrier/activator assembly 28 is in its extrememost right position when the device 10 is at rest.

The applicator sleeve 14, in the preferred embodiment, has the shape ofan elongated tube with a step down 30 formed in its distal end. Whilethe applicator sleeve 14, in the preferred embodiment, is generallydescribed as tubular and circular in cross section throughout themajority of its length, other cross-sectional shapes could be employed.The applicator sleeve has fingers 32 (FIG. 6 c) curled over the stepdown portion 30 of its distal end. The pre-clamp arm 26 sits in the stepdown portion 30 of the applicator sleeve and fits within the envelopedefined by the outer perimeter of the applicator sleeve 14 if that outerperimeter were extended beyond the left most tip of the device 10.

The pre-clamp arm 26 is elongated and, in the preferred embodiment, hasan elongated slot 34 (FIG. 4 b) defined by the two side arms 36, 36′.Depending nose 38 (FIG. 6 a) is provided at the left end of thepre-clamp arm 26 and connector extension 40 (FIG. 4 b) is formed withthe pre-clamp arm 26 at its right end. Connector extension 40 has a hole42 (FIG. 6 a) through it and is formed with a camming surface 44 in thebottom right portion thereof.

A carrier arm 46 (FIG. 6 a) extends from the applicator sleeve 14 beyondthe step down portion 30 toward the distal end of the device. Thecarrier arm 46 may be U-shaped in cross section or any other convenientconfiguration. In the preferred embodiment, the carrier arm 46 isU-shaped and has a base 48 and upwardly projecting legs 50. A pin 52extends through hole 42 and through holes in the legs 50 to connect thepre-clamp arm 26 to the carrier arm 46. The carrier arm 46 has a step up54 along the base 48 and located beneath the camming surface 44. Aspring 56 is connected to the carrier arm 46 and the bottom of thepre-clamp arm 26, directly to the left of the pivot point of connectionpin 52. The spring 56 is biased such that it tends to pressure thepre-clamp arm 26 for clockwise movement (as viewed in FIG. 6 a) aboutthe pivot point 52.

Extending through the length of the applicator sleeve 14 along the upperside thereof is push rod 58. A ramp 60 is formed in the left end of pushrod 58, and when the device is at rest, the push rod 58 is pushed to theleft as can be seen in FIG. 4 a. When push rod 58 is extended to itsleft most extreme position, the camming surface 44 rides over the ramp60, forcing the pre-clamp arm 26 to rotate about the pivot point 52 in acounter clockwise direction into the closed position as shown in FIG. 4a. The pressure of the camming surface 44 riding over the ramp 60 andforcing the counter clockwise rotation of the pre-clamp arm 26 about thepivot point 52 overcomes the pressure of spring 56 to hold the pre-clamparm in a “closed” position. In the “closed” position, the depending nose38 extends down and over the extreme left end of the applicator sleeve14. Pre-clamp arm 26 does not move length-wise relative to the length ofthe applicator sleeve 14, its only movement is to pivot about the pin 52being urged by spring 56 in a clockwise rotation to an open positionwhen a push rod 58 is retracted toward the proximal end of the deviceand being rotated counter clockwise about pin 52 to the closed positionwhen the push rod 58 is advanced toward the distal end of the device 10and the camming surface 44 is forced to ride over the ramp 60.

In operation, the purpose of the pre-clam arm 26 is to fit over a bloodvessel or artery 62 (See FIG. 6 a) and to flatten the vein so that itwill be dimensionally sized to fit within the mouth of ligation clip 16when pressure arm 22 is rotated in a clockwise direction to open theclip.

The ligation clip carrier/activator assembly 28 will now be described.In the at rest position, the ligation clip carrier/activator assembly 28is retracted into the applicator sleeve 14 toward the proximal end ofthe device as is shown in FIG. 4 a. In the at rest position, device 10is inserted through a trocar for use in a surgical procedure. Once thedevice 10 is inserted through a trocar into a body cavity, the clipcarrier/activator assembly 28 is advanced to the ready position shown inFIG. 5 a. The assembly 28 is captured on the distal end of the devicebeneath the fingers 32. The assembly 28 includes clip carriage 64 andwings 66. The clip carriage 64 is an elongated element that fits withinthe applicator sleeve 14 and is telescopically moveable within theapplicator sleeve 14. The clip carriage 64 also extends beneath thewings 66 as can be seen in FIGS. 10 a and 10 b.

The ligation clips 16 are stacked within the clip carriage 64 with theproximal end 24 of each clip aligned to the right as is seen in FIG. 2a. The trunk 68 (FIG. 10 a) of the clip carriage 64 is that portion ofthe clip carriage to the right of the assembly 28 as shown in FIG. 4 a.The cross section of the trunk 68 of the clip carriage 64 is shown inFIG. 11. As can be seen from FIG. 11, the cross section of the trunk 68is shaped to mate with the cross section of the ligation clips 16 sothat the ligation clips 16 will be held in stacked alignment through thelength of the trunk 68. A plate and spring (not shown) are incorporatedin the extreme right end of the trunk 68 of the clip carriage 64 toapply pressure against the proximal end 24 of the clip in the extremeright location of the device 10. The spring applies force against theplate to pressure the clips toward the distal end of the device. Thus,after each clip is applied to a vein, another clip is forced into aready position for application to another vein.

In the region of the clip carrier/activator assembly 28 (see FIG. 4 a),the clip carriage has a modified cross section. The general shape of thecross section of the clip carriage 64 in the region of the clipcarrier/activator assembly 28 is shown in FIG. 12. As can be seen there,clip carriage 64 has a substantially semi-circular outer perimeter (theouter perimeter is of a shape to mate with the shape of the innersurface of the channel through the applicator sleeve 14), and the shapeof the interior portion of the clip carriage 64 at this point isdesigned to mate with the lower portion of the cross sectional shape ofthe ligation clip 16. However, beneath the channel formed by the twolegs of the U-shaped base 20 of the clip 16 is a channel to house theligation clip opening assembly. At this cross-sectional point of thedevice, above the base portion of the clip carriage 64 are located thewings 66. Wings 66 have an elongated dimple 72 of a shape to mate withthe upper and outer perimeter of the ligation clip 16. Because the wings66 are held beneath the fingers 32, the elongated dimple 72 allows thewings to hold the clip in place against the pressure necessary to openthe clip in the fashion that will be disclosed herein.

The ligation clip opening assembly housed in the bottom most portion ofthe clip carriage 64 includes a depressor 74 (FIG. 6 a). The depressor74 is generally pencil shaped, approximately the length of the channelbetween the two legs of the base 20 of the ligation clip 16 and of across sectional profile of a size that will allow at least a portion ofthe depressor 74 to extend through the channel between the two legs ofthe base 20 of the ligation clip 16. The depressor 74 is pivotallyconnected at 76 at its distal end to the upwardly projecting side wallsof the clip carriage 64 and is permitted limited rotation about itspivotal connection 76. When the depressor 74 is in the at rest position,it lies flat along the base 78 of the clip carriage 64. A stopprotrusion 80 is located on the depressor 74 to the left of the pivotalconnection 76 to limit the rotation of the depressor 74. The depressor74, from its at rest position, can only rotate in a counter clockwisedirection (as viewed in FIG. 6 a) and is limited in its movement becausethe stop protrusion 80 will engage the base 78 of the carriage assembly64 after a limited counter clockwise rotation.

The depressor 74 has a cam surface 82 at its proximal end. The camsurface 82 is in contact with the distal end of the clip actuation pushrod 84. The clip actuation push rod 84 is an elongated rod that fitswithin a channel in the base of the clip carriage 64 and is allowed tomove to and fro within that channel from the at rest position shown inFIG. 6 a to the trigger position shown in FIG. 7 a and back to the atrest position of FIG. 6 a. When the clip actuation push rod 84 isadvanced to the left into the trigger position shown in FIG. 7 a, thecam surface 82 of the depressor 74 rides up over the end of the clipactuation push rod 84 to rotate the depressor in a counter clockwiseposition. The proximal end of the depressor protrudes into the channelbetween the two legs of the base 20 of the ligation clip 16 against theunder side of the pressure arm 22 of the clip and forces the clip intothe open position shown in FIG. 2 d and in FIG. 7 a. As the ligationclip 16 is being opened by the action of the depressor 74 against thepressure arm 22 of the clip, the entire clip carriage assembly isadvanced toward the distal end of the device 10 in relationship to theapplicator sleeve 14 so that the clip will capture the vessel 62 thathas been flattened by the action of the pre-clamp arm 26. The vesselwill then be captured between the upper surface of the base 20 of theligation clip 16 and the lower surface of the pressure arm 22 of theligation clip 16 and the clip actuation push rod 84 can be retractedtoward the proximal end of the device, allowing the depressor 74 torotate back into the at rest position and release the pressure arm 22 tocapture and close the vessel 62.

The next step in the procedure is to advance the clip carriage assembly64 relative to the applicator sleeve 14 beyond the distal end of theapplicator sleeve 14 (See FIGS. 10 a and b). The wings 66 are connectedto the clip carriage 64 by ribbon springs 86. The ribbon springs 86 areloaded to pressure the wings 66 to fan away from each other in themanner shown in FIG. 10 b. The wings 66 will remain in parallelrelationship so long as they are held within the applicator sleeve 14;however, once the wings 66 extend beyond the proximal end of theapplicator sleeve 14, they are free to follow the pressure of the ribbonsprings 86 and fan away from each other. The opening of the wings 66releases the clip from the restraint of the elongated dimple 72 and thusthe clip 16 is released from the device. The distal tip of the devicecan be tipped slightly to allow the ligation clip 16 to clear the device10 as the clip 16 holds onto the vessel 62 in the clamped position. Atthis point, the clip carriage assembly is retracted toward the proximalend of the device relative to the applicator sleeve 14, the wings arereturned within the confines of the applicator sleeve 14, another clipis released to advance to the ready position and the procedure can beperformed again.

The mechanism for activating the pre-clamp arm and the clip assemblywill now be described. Referring to FIG. 3, a cut away portion of theapplicator sleeve shows the push rod 58 and the clip actuation push rod84. The pistol grip 12 is shown with the cover removed so that theoperation of the device can be described. The housing 88 of the pistolgrip 12 can be constructed of any convenient sturdy material. Within thehousing 88 of the pistol grip 12 is a pre-clamp push rod lever 90 whichis hinged at 92 via a pin connected to housing 88. The pre-clamp pushrod lever 90 has opposing ends, one end 94 pivotally connected to theproximal end of push rod 58 and the opposite end connected at pivotpoint 96 to the trigger 98. The trigger 98 fits within slots 100, 100′which allows the trigger 98 to traverse back and forth within the slots100, 100′ in response to pressure on the trigger by the user of thedevice 10. The return spring 102 is an expansion spring connected at oneend against a stop 104 and at the other end against the inside of thetrigger 98. Thus, a user of the device applies pressure to the trigger98 to force the trigger 98 to move to the right within the slots 100,100′. The trigger 98 will return to its at rest position (its positionto the extreme left within the device shown in FIG. 3) when the pressureapplied by the user is released. When the trigger 98 is activated bypressure from the user to move the trigger 98 to the right, the lever 90rotates about the pin point 92. The end at connection point 96 of lever90 will move toward the proximal end of the device 10 and the end atpivot point 94 will move in the direction of the distal end of thedevice 10, thus causing the push rod 58 to move toward the distal end ofthe device 10 and causing the ramp 60 to ride beneath the cammingsurface 44 and force the pre-clamp arm 26 into a closed position.

In the use of the device, the trigger 98 will be activated by the userto close the pre-clamp arm 26 while the device is being inserted througha trocar. Once a vein 62 that is to be ligated is located, the trigger98 will be released, the pressure of spring 92 will force the trigger tomove to the at rest position thereby rotating the lever 90 in aclockwise direction, retracting the push rod 58 toward the proximal endof the device and allowing the pre-clamp arm 26 to open. The device 10will then be manipulated so that a vessel 62 is captured between theupper surface of the fingers 32 and the lower surface of the arm 26 andtoward the proximal end of the depending nose 38 of the device. Once thevessel 62 is in position, the trigger 98 is activated by the user tocause a counter clockwise rotation of the lever 90 forcing the push rod58 toward the distal end of the device and causing the pre-clamp arm torotate counter clockwise about the pin 52 and compress the vessel 62 inthe manner shown in FIG. 7 a. While holding the trigger 98 in theactivated position, thus holding the pre-clamp arm 26 against the vessel62 in the manner shown in FIG. 7 a, the user of the device nextactivates the clip carrier/activator assembly 28 through the use of theactivator key 106.

Key 106 is contained within the housing 88 of the pistol grip 12 inslots similar to the slots 100, 100′ which retain the trigger 98. Key106 is allowed to move between an at rest position as is shown in FIG. 3and an activated position which is to the right of the at rest position.Spring 108 is connected at one end to stop 110 and at the other end tothe inside of the key 106. Spring 108 is an expansion spring which tendsto force the key 106 to the at rest position shown in FIG. 3.

Clip carriage actuation lever 112 is pivotally connected to the housing88 at pivot point 114. Lever 112 extends down from pivot point 114 to apivot connection 116 between the depending leg of the lever 114 and thekey 106. Thus, when the key 106 is activated, moving it in the directionof the proximal end of the device, the lever 112 is rotated in a counterclockwise direction about the pivot point 114. Moving the lever 112 in acounter clockwise direction about the point 114 causes the upper leg ofthe lever 112 to move generally toward the distal end of the device. Theupper portion of the lever 112 is connected to the clip carriage 64 viathe link 118. The link 118 is pivotally connected at one end 120 to thelever 112 and at the opposite end 122 to a boss 124 formed on the clipcarriage 64. By the linkage just described, when the key 106 isactivated, the clip carriage 64 moves toward the distal end of thedevice relative to the applicator sleeve 14 which at all times remainsin a fixed position in relationship to the housing 88 of the pistol grip12. By activating the key 106, through the operation of the clipactuation cam follower 126, the clip actuation push rod 84 is advancedrelative to the clip carriage 64 concurrently with the movement of theclip carriage 64 relative to the sleeve 14. The clip actuation camfollower is pivotally connected at 128 to the upper portion of the lever112 so that when the upper portion of the lever 112 moves in thedirection of the distal end of the device, the cam follower 126 ridesover the clip actuation cam 130 causing the clip actuation cam follower126 to rotate in a clockwise direction relative to the lever 112. Theclip actuation push rod 84 is connected at its proximal end to thedepending leg of the clip actuation cam follower 126 at 132. Thus, theclip actuation push rod 84 moves toward the distal end of the devicerelative to the clip carriage assembly 64 and causes the depressor 74 toride over the distal end of the clip activation push rod, forcing thedepressor upwardly against the pressure arm 22 of the ligation clip 16.

By the mechanism described, the activation of key 106 advances the clipcarriage assembly to the position shown in FIG. 7 a. Continued pressureon the key 106 advances the clip actuation cam follower 126 over theclip actuation cam 130 so that the follower 126 disengages from the cam130. A coil spring (not shown) is provided at the pivot point 128tending to force the cam follower 126 to rotate in a counter clockwisedirection. Thus, as soon as the cam follower 126 releases from the cam130 after it passes over the cam 130, the spring about the pivot point128 will force the cam follower 126 to rotate in a counter clockwisedirection thereby causing the clip actuation push rod 84 to retracttoward the proximal end of the device. When the clip actuation push rod84 retracts toward the proximal end of the device, the pressure of thedepressor 74 is relieved from the underside of the pressure arm 22 andthe pressure arm 22 closes on the vessel 64, capturing the vessel 64between the underside of the pressure arm 22 and the top side of thebase 20 of the clip 16.

To release the clip 16 from the device, additional pressure is appliedto the key 106 thus forcing the clip assembly 64 to advance further inthe direction of the distal end of the device relative to the stationarysleeve 14, forcing the wings 66 beyond the distal end of the sleeve 14so that wings 66 may fan open and release the clip 16.

In order to return the device to the at rest or ready position forinsertion of another clip, pressure on the key 106 is released. Spring108 forces the key 106 toward the proximal end of the device thusrotating the lever 112 about the point 114 in a clockwise direction. Theentire device is then reset. The cam follower 126 is allowed to passback to the ready position by virtue of the pivotal connection of thecam 130 to the housing 88. The cam 130 is pivotally connected at 134 tothe housing 88 and the cam 130 has a ramp 136 formed on the surface ofthe cam 130 that faces the housing 88 of the grip 12 shown in FIG. 3.The cam 130 has a spring (not shown) tending to force the cam 130against the housing 88 as shown in FIG. 3. When the cam follower 126 isreturned to the at rest position, it will ride against the ramp 136causing the cam 130 to rotate about the pivot point 134 and slip upslightly to allow the cam follower 126 to pass between the cam 130 andthe housing 88. Once the cam follower 126 clears the cam 130, the springwill rotate the cam 130 back to the ready position as is shown in FIG.3.

Relieving the pressure on the key 106 also causes the clip cartridge 64to retract toward the proximal end of the device into the readyposition.

A locking lever 137 is also provided on the lever 112 and pivotallyconnected to the lever 112 at point 138. The locking lever 137 fits overthe lever 90 so that when the key 106 is in the at rest position and thelever 112 is rotated into its clockwise most position, the locking lever137 will hold the lever 90 in the position that would occur if thetrigger 98 were depressed. Thus, the push rod 58 is advanced forward tocause the pre-clamp arm 26 to be closed. This locking lever allows thedevice to be inserted through a trocar without the user having to holdthe trigger 98 in an activated position. In operation, once pressure isapplied to the key 106, the pressure of the locking lever 137 on thelever 90 is released allowing the spring 102 to push the trigger 98toward the distal end of the device thereby retracting the push rod 58and allowing the pre-clamp arm 26 of the device to open. Once thepre-clamp arm of the device is open, the pre-clamping pressure on avessel 62 is created by activation of the trigger 98, thus forcing thepush rod 58 toward the distal end of the device and causing thepre-clamp arm to close against the fingers 32.

Once a clip has been applied in the manner described, a second clip isloaded into the ready position from the clip carriage 64 by themechanism illustrated in FIGS. 13 a and 13 b forcing the ligation clip16 to advance toward the distal end of the device.

The mechanism shown in FIGS. 13 a and 13 b is mounted in the pistol grip12 directly adjacent link 118. The mechanism shown in FIGS. 13 a and 13b is not illustrated in FIG. 3 for purpose of clarity. However, theadditional mechanical structures shown in FIGS. 13 a and 13 b aremounted directly above link 118 and in engagement therewith.

Referring now specifically to FIGS. 13 a and 13 b, there is illustrateda clip pushrod 154 which is slidably mounted within the pistol grip 12and permitted to move in a lineal direction along its length. The distalend 156 of the clip pushrod 154 will be in engagement with the rear mostligation clip 16 in the magazine of clips positioned in the carriagepassageway. Movement of the clip pushrod 154 toward the distal end ofthe device will force the forward most ligation clip 16 into thecarriage assembly.

The controlling mechanism for advancing the ligation clips is providedby link 118 which has teeth 119 on the upper edge thereof in matingengagement with teeth 151 on the outer perimeter of the one-way ratchetclutch 150. The cog wheel 152 is mounted to rotate with the one-wayratchet clutch 150 and is coaxially aligned with the one-way ratchetclutch 150. The cogs 153 on the cog wheel 152 engage the cog ports 155in the clip pushrod 154. In operation, as can be seen from FIG. 13 b,upon forward motion of link 118 as is shown by the arrow in FIG. 13 b,the one-way ratchet clutch 150 will rotate counter clockwise, but cogwheel hub 158 will not rotate because the teeth 159 protruding from thecog wheel hub 158 will ratchet over the ramped ratchet teeth 160.However, when the link 118 moves in the reverse direction, theengagement between the teeth 119 on the link 118 and the teeth 151 willcause the one-way ratchet clutch 150 to rotate in a clockwise direction,causing the tooth face 161 to engage the teeth 159 and rotate the hub158 in a clockwise direction. FIG. 13 b is viewed from the bottom of theassembly shown in FIG. 13 a; thus, when viewed from the top, the onlyrotational movement of the cog wheel 152 will be in a counter clockwisedirection upon the movement of the link 118 toward the proximal end ofthe device. When the link 118 moves toward the distal end of the device,the ratcheting mechanism will cause the cog wheel 152 to remainstationary.

The operation of the assembly shown in FIGS. 13 a and 13 b will therebycontrol the movement of a clip 16 from the ready position into thecarriage assembly as follows: when the device is being reset, link 118moves to the rear, causing cog wheel 152 to rotate, advancing clippushrod 154 to load a new clip into the clip carriage. When themechanism is activated and the link 118 moves forward, the cog wheel 152remains stationary so that the clips 16 in the clip magazine do notadvance. Thus, the mechanism as described retains the clips in the readyposition until the mechanism is activated by the retracting carriageassembly 64 rotating the cog wheel 152 and advance the clip pushrod 154so that a single clip moves forward and is permitted to advance into thecarriage assembly.

As can be seen from FIG. 3, the device of the present invention can beused in a number of different procedures and the applicator sleeve 14and related assemblies can be removed from the pistol grip and replacedwith a clean sterile sleeve 14 for a second operative procedure with anew patient. The device is provided with a hinged cover 140 which ishinged to the housing 88 at 142. The closure mechanism 140 can be heldin place by any convenient safety latch 144 (see FIG. 1). The housing isprovided with upper and lower recesses 146 and 148 and the sleeve 14 canbe provided with bosses (not shown) that fit within the upper and lowerrecesses 146, 148 to stabilize the position of the applicator sleeve 14in relationship to the pistol grip 12. The pivotal connections 94, 122and 132 can be designed so that the pins will slidably engage within theopenings to permit the applicator sleeve 14 and related parts to belifted from the pistol grip 12 and replaced by an applicator sleeveloaded with fresh ligation clips 16. To make this replacement, it isnecessary that the face of the pistol grip 12 be removable from thepistol grip and have means for connecting the face onto the pistol grip12 in a fixed relationship. Any convenient latching mechanism can beprovided to connect the face of the pistol grip onto the body of thepistol grip 12.

Thus, although there have been described particular embodiments of thepresent invention of a new and useful “Low Profile Tool for ApplyingSpring Action Ligation Clips”, it is not intended that such referencesbe construed as limitations upon the scope of this invention except asset forth in the following claims. Further, although there have beendescribed certain dimensions used in the preferred embodiment, it is notintended that such dimensions be construed as limitations upon the scopeof this invention except as set forth in the following claims.

1. A combination of a surgical ligation clip for ligating a vessel and aligation clip applier for applying the ligation clip to the vessel, thecombination comprising: said ligation clip comprising a continuouslength of material, said material having an elongated member having aproximal end, an opposite distal end, and a length therebetween, saidmaterial having an elongated arm having a proximal end, an oppositedistal end, and a length therebetween, said arm having a vesselcontacting surface oriented toward said member, said member having asurface oriented toward said vessel contacting surface of said arm, saidarm and said member being biased toward one another in an open position,said material having a connector having a maximum length, and a maximumheight perpendicular to the maximum length of said connector, saidconnector connecting said member and said arm, said clip having alongitudinal axis, a proximal end, an opposite distal end, and a lengththerebetween, said clip having a width proximate said distal end of saidclip that is greater than a width proximate said proximal end of saidclip, said surface of said member along at least a portion of the lengthof said member having a width corresponding to the width proximate saiddistal end of said clip, wherein one of said arm and said memberincludes a portion at said distal end thereof generally oriented alongthe longitudinal axis of said clip, and the maximum length of saidconnector is oriented along the longitudinal axis of said clip, themaximum length of said connector approximating the maximum height ofsaid connector; and said clip applier comprising a proximal end, anopposite distal end, a length therebetween, and an opener pivotablyattached to said clip applier proximate said distal end, said openerbeing actuatable from a first position to a second position, and saidopener being adapted to contact said arm to move said clip to the openposition upon actuation thereof toward the second position.
 2. The clipof the combination of claim 1, wherein said surface of at least one ofsaid arm and said member is treated to enhance gripping of the vessel.3. The clip of the combination of claim 2, wherein said surface includesat least one of ridges, notches, burrs, and etching.
 4. The clip of thecombination of claim 1, wherein said connector includes a coil biasingsaid arm and said member toward one another in the open position.
 5. Theclip of the combination of claim 1, wherein said continuous length ofmaterial of at least one of said member and arm has a non-circular crosssection along at least a portion of its length.
 6. A combination of asurgical ligation clip for ligating a fluid carrying structure and aligation clip applier for applying the ligation clip to the fluidcarrying structure, the combination comprising: said ligation clipcomprising: a longitudinal axis, a distal end, and a proximal endopposite said distal end; a clamping arm oriented generally along thelongitudinal axis of said clip, said clamping arm including a portion atsaid distal end of said clip generally oriented along the longitudinalaxis; a support member oriented generally along the longitudinal axis ofsaid clip, said support member including a portion at said distal end ofsaid clip generally oriented along the longitudinal axis; and aconnector at said proximal end of said clip having a maximum lengthoriented along the longitudinal axis, and a maximum height perpendicularto the maximum length of said connector, the maximum length of saidconnector approximating the maximum height of said connector, saidconnector joining said support member and said clamping arm, said clipbeing formed of a continuous length of material having a first free endterminating at said connector and a second free end terminatingproximate said distal end of said clip; and said clip applier comprisinga proximal end, an opposite distal end, a length therebetween, and anopener pivotably attached to said clip applier proximate said distalend, said opener being actuatable from a first position to a secondposition, and said opener being adapted to contact said clamping arm tomove said clip to an open position upon actuation thereof toward thesecond position.
 7. The clip of the combination of claim 6, wherein saidconnector is adapted to bias said support member and said clamping armtoward one another in a closed position.
 8. The clip of the combinationof claim 6, wherein said connector includes a coil.
 9. The clip of thecombination of claim 6, wherein a surface of at least one of saidclamping arm and said support member is treated to enhance gripping ofthe fluid carrying structure.
 10. The clip of the combination of claim9, wherein said surface includes at least one of ridges, notches, burrs,and etching.
 11. The clip of the combination of claim 6, wherein saidcontinuous length of material of at least one of said support member andclamping arm has a non-circular cross section along at least a portionof its length.
 12. The clip of the combination of claim 1, wherein theother of said arm and said member includes a portion at said distal endthereof generally oriented along the longitudinal axis.
 13. The clip ofthe combination of claim 1, wherein the length of said connector is lessthan half of the lengths of said arm and said member.
 14. The clip ofthe combination of claim 1, wherein said connector biases said distalend of said arm away from said distal end of said member while said clipis in a closed and unengaged position.
 15. A combination of a surgicalligation clip for ligating a fluid carrying structure and a ligationclip applier for applying the ligation clip to the fluid carryingstructure, the combination comprising: said ligation clip comprising: alongitudinal axis, a distal end, and a proximal end opposite said distalend; a support member having a maximum length oriented generally alongthe longitudinal axis of said clip; a clamping arm having a maximumlength oriented generally along the longitudinal axis of said clip, saidclamping arm being biased toward said support member; and a connectorhaving a maximum length oriented along the longitudinal axis, and amaximum height perpendicular to the maximum length of said connector,the maximum length of said connector approximating the maximum height ofsaid connector, and being less than half of the maximum lengths of oneof said support member and said clamping arm, said clip being formed ofa continuous length of material having a first free end terminatingproximate said proximal end of said clip and a second free endterminating proximate said distal end of said clip; and said clipapplier comprising a proximal end, an opposite distal end, a lengththerebetween, and an opener pivotably attached to said clip applierproximate said distal end, said opener being actuatable from a firstposition to a second position, and said opener being adapted to contactsaid clamping arm to move said clip to an open position upon actuationthereof toward the second position.
 16. The clip of the combination ofclaim 15, wherein said clip includes a first bend section between saidsupport member and said clamping arm.
 17. The clip of the combination ofclaim 16, wherein said support member includes a second bend section.18. A combination of a surgical ligation clip for ligating a fluidcarrying structure and a ligation clip applier for applying the ligationclip to the fluid carrying structure, the combination comprising: saidligation clip comprising: a longitudinal axis, a distal end, and aproximal end opposite said distal end; a clamping arm having a proximalend, a distal end opposite said proximal end, and a length therebetween,a portion of the length of said clamping arm at said distal end beinggenerally parallel to the longitudinal axis; a support member having aproximal end, a distal end opposite said proximal end, and a lengththerebetween, a portion of the length of said support member at saiddistal end being generally parallel to the longitudinal axis; and aconnector at said proximal end of said clip for connecting said clampingarm and said support member, said connector having a maximum lengthoriented along the longitudinal axis, and a maximum height perpendicularto the maximum length of said connector, the maximum length of saidconnector approximating the maximum height of said connector, and beingless than half of the lengths of one of said clamping arm and saidsupport member, said connector spacing said clamping arm and saidsupport member apart from one another along a majority of the lengthsthereof, and allowing for movement of said clamping arm and said supportmember relative to one another; and said ligation clip appliercomprising a proximal end, an opposite distal end, a lengththerebetween, and an opener pivotably attached to said clip applierproximate said distal end, said opener being actuatable from a firstposition to a second position, and said opener being adapted to contactsaid clamping arm to move said clip to an open position upon actuationthereof toward the second position.
 19. A combination of a surgicalligation clip for ligating a fluid carrying structure and a ligationclip applier for applying the ligation clip to the fluid carryingstructure, the combination comprising: said ligation clip comprising: alongitudinal axis, a distal end, and a proximal end opposite said distalend; a clamping arm having a proximal end, a distal end opposite saidproximal end, and a length therebetween, a portion of the length of saidclamping arm at said distal end being generally parallel to thelongitudinal axis; a support member having a proximal end, a distal endopposite said proximal end, and a length therebetween, a portion of thelength of said support member at said distal end being generallyparallel to the longitudinal axis; and a connector at said proximal endof said clip for connecting said clamping arm and said support member,said connector having a maximum length oriented along the longitudinalaxis, and a maximum height perpendicular to the maximum length of saidconnector, the maximum length of said connector approximating themaximum height of said connector, said clamping arm and said supportmember spaced apart from one another along a majority of the lengthsthereof, said connector allowing for movement of said clamping arm andsaid support member relative to one another; and said ligation clipapplier comprising a proximal end, an opposite distal end, a lengththerebetween, and an opener pivotably attached to said clip applierproximate said distal end, said opener being actuatable from a firstposition to a second position, and said opener being adapted to contactsaid clamping arm to move said clip to an open position upon actuationthereof toward the second position.